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Integrated Delivery Networks (IDNs) offer both healthcare services and health insurance coverage to patients within a geographic area. Each IDN is unique in its function and offerings, but generally provide primary care, acute care, specialty care (including clinics), long-term care, and home health care. IDNs often leverage their size to increase purchasing power, negotiating lower prices with medical device suppliers for their member facilities.

The following table lists the top 50 IDNs in the U.S. according to average daily census. The IDN with the highest average daily census on our list, HCA Healthcare, leads by a significant margin. With an average daily census of 24,333, the gap between the first and second spot on our list exceeds 10,000 patients. HCA consists of 211 in-network hospitals. The average number of in-network hospitals for IDNs in the top 50 comes in at just over 48.

On average, the top 50 IDNs brought in more than $7.9 billion in net patient revenue during the most recent reporting period. This is less than one-fifth of the net patient revenue earned by HCA Healthcare, the largest IDN.

Top 50 IDNs by Average Daily Census

IDN Name

Definitive ID

Net Patient Revenue

# of Hospitals

Avg. Daily Census

1.

HCA Healthcare

4710

$42,213,477,560

211

24,333.50

2.

Universal Health Services

7055

$9,212,756,052

172

13,394.70

3.

CommonSpirit Health

981465

$28,543,327,983

203

11,822.50

4.

Ascension Health

4695

$17,858,985,891

125

8,799.40

5.

Tenet Healthcare

4685

$13,721,002,396

84

7,559.20

6.

Trinity Health

4712

$13,117,384,362

58

6,486.60

7.

Community Health Systems

542233

$10,780,259,686

109

6,267.80

8.

Encompass Health Corporation

7277

$3,182,735,641

135

6,066.30

9.

Providence St Joseph Health

4716

$15,696,161,401

57

5,920.40

10.

Kaiser Permanente

4713

$13,261,153,753

43

4,543.80

11.

Dignity Health

4698

$11,817,607,947

48

4,289.30

12.

Northwell Health

4744

$9,410,545,687

23

4,201.40

13.

Select Medical Corporation

7013

$2,284,089,486

115

4,187.50

14.

AdventHealth

4694

$7,759,295,166

38

4,013.30

15.

University of Pittsburgh Medical Center

6448

$8,056,954,680

36

3,993.50

16.

Kindred Healthcare

7048

$2,118,980,726

80

3,972.40

17.

Atrium Health

4697

$7,930,837,733

39

3,519.70

18.

Bon Secours Mercy Health

975303

$7,665,638,269

39

3,458.10

19.

LifePoint Health

7004

$8,059,322,200

86

3,389.60

20.

Advocate Aurora Health

965729

$7,919,307,404

30

3,315.10

21.

Cleveland Clinic Health System

274173

$8,763,122,200

19

3,145.70

22.

NewYork-Presbyterian Healthcare System

7066

$7,698,677,961

12

3,041.90

23.

New York State Office of Mental Health

552464

$47,760,344

*Net Medicare Revenue

24

3,036.00

24.

Banner Health

4732

$5,978,246,087

31

3,027.10

25.

University of California (UC) Health

560423

$12,063,083,551

20

2,940.30

26.

Baylor Scott & White Health

577357

$7,121,201,390

51

2,913.80

27.

Partners HealthCare

7001

$7,599,868,208

15

2,709.70

28.

Prime Healthcare Services

542003

$4,376,608,561

46

2,699.30

29.

Acadia Healthcare

7230

$826,419,744

38

2,585.50

30.

Mercy (MO)

7027

$4,963,556,308

37

2,535.40

31.

Steward Health Care System

4684

$4,358,628,896

39

2,521.50

32.

RWJBarnabas Health

835851

$4,788,607,968

16

2,491.00

33.

NYC Health and Hospitals

7112

$5,626,899,758

12

2,489.80

34.

HCA East Florida Division

780654

$3,354,022,598

14

2,383.10

35.

CHRISTUS Health

4702

$4,422,891,997

35

2,378.90

36.

SSM Health

6446

$4,763,284,753

30

2,263.90

37.

Memorial Hermann Health System

7017

$4,459,894,281

21

2,239.60

38.

Hackensack Meridian Health

829066

$4,502,658,114

16

2,183.30

39.

HCA Gulf Coast Division

780655

$2,911,673,551

16

2,170.20

40.

Montefiore Health System

2754

$3,972,696,844

10

2,153.80

41.

BJC HealthCare

7076

$4,900,898,464

16

2,130.10

42.

Sutter Health

4717

$6,676,610,412

30

2,105.20

43.

Beaumont Health System

4746

$4,212,484,651

8

2,101.40

44.

Advocate Health Care

4740

$4,514,464,031

15

2,084.70

45.

HCA West Florida Division

780653

$2,774,637,519

17

2,082.20

46.

Kaiser Permanente Northern

California

845347

$7,224,288,886

21

2,080.20

47.

Texas Health Resources

6447

$4,209,720,101

29

2,064.20

48.

BayCare Health System

7067

$3,339,878,904

17

2,064.20

49.

Mercy Health

4715

$3,989,902,894

23

2,047.40

50.

Mount Sinai Health System

577655

$5,166,329,392

9

2,034.60

Fig 1. Data from Definitive Healthcare based on combined net patient revenue reported by IDN member hospitals from fiscal year 2018, the most recent data available. Average Daily Census based on compilation of reports from IDN member hospitals. Aggregate of Member Hospital Financial Information from CMS Medicare Cost Report.